Obsessive Compulsive Disorder and Suicide
Christina L Boisseau, PhD examines the link between Obsessive Compulsive Disorder and suicide. She shares how her approach to the underlying diatheses both within and across traditional diagnostic categories has redefined how clinicians look at the risk of suicide with in the population of OCD patients.
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Learn more about Christina L. Boisseau, PhD
Christina L. Boisseau, PhD
Christina L. Boisseau, PhD received her BS in Psychology from Duke University and her MA and PhD in Clinical Psychology from Boston University. She completed a predoctoral residency and a postdoctoral fellowship at Brown University, and was an Assistant Professor (Research) in the Department of Psychiatry and Human Behavior at Brown before joining the faculty of Northwestern as an Associate Professor in the fall of 2018.Learn more about Christina L. Boisseau, PhD
Transcription:
Obsessive Compulsive Disorder and Suicide
Melanie Cole (Host): Hello. Today, we are examining the relationship between OCDs and suicide. My guest today, is Dr. Christina Boisseau. She’s an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Northwestern Medicine. Dr. Boisseau, tell us a little bit about yourself to begin with and how you came to Northwestern Medicine.
Christina L. Boisseau, PhD (Guest): Yeah so, as you mentioned, I’m an Associate Professor in the department. And I actually joined the faculty at Northwestern earlier this year. And so, prior to that, I was faculty at Brown Medical School. And so really as part of my role here at Northwestern, I conduct clinical research, I also see patients, focus on OCD and anxiety disorders and I’m also the Associate Director of our Clinical Psychology Internship Training Program. So, I came from Brown and I’m a more recent transplant to Chicago.
Host: Well, we are so glad to have you here. Your research background, includes work investigating anxiety and obsessive compulsive spectrum and eating disorders. Tell us about your approach when you are examining the underlying diatheses both within and across the traditional diagnostic categories.
Dr. Boisseau: Well traditionally, researchers have focused on examining diagnostic categories. For example, individuals with social anxiety, individuals with panic disorder, individuals with depression and really my perspective is that there are more similarities than differences across these traditional diagnostic categories. So, for example, for a while we were treating all of these disorders with different treatment protocols. So, we had a different protocol for social anxiety, a different protocol for panic disorder, something different for depression. But really the treatment principles are largely the same.
So, in part of my work, I was part of the team that developed the unified protocol for transdiagnostic treatment of emotional disorders which essentially takes a more parsimonious approach and distills valid elements of existing empirically supported treatments to make a single protocol that can be used for many different conditions. And so, we think that this will be more easily disseminated to clinicians in the community because now you can use one protocol for social anxiety and OCD and depression instead of all of those disparate protocols.
More recently, my research has focused more on the translational aspect and so currently, we are examining underlying motivation across OC spectrum and anxiety disorders, really with the ultimate goal of delineating a circuit based model of the same. And here, we are focusing more on core motivation as opposed to whether or not an individual has let’s say social anxiety or hoarding. Really, we are looking at kind of why an individual does the behavior that they do.
Host: Typically, and before we discuss your research, Dr. Boisseau, are people with OCD who have these unwanted thoughts about hurting themselves or others; are they at a higher risk of acting on their fears?
Dr. Boisseau: No, not at all. And so, the thing to know about OCD is these are the people who are very, very afraid of their thoughts. So, they might have an intrusive thought of hurting a loved one. A common thing we often call them taboo thoughts because they are taboo in society is they have a thought if they pick up a knife, they are going to stab their loved one. And it’s really important to realize as a community that individuals with OCD are the least likely people to do this. They are afraid of this. They do anything in their power to not have these thoughts. So, these are the people who won’t go in their kitchen for example, because there are knives present. These are people who won’t hug their loved ones because they are afraid that something terrible is going to happen even if they may not be able to say what that terrible thing is.
Host: Wow, that’s fascinating. And you’ve recently published findings in the Journal of Affective Disorders, regarding obsessive compulsive disorders and suicide. Tell us about the background of your work and what the study sought to find.
Dr. Boisseau: Yeah, so the study was actually spearheaded by one of our collaborators. Her name is Dr. Lily Brown and she’s at U Penn and it was really designed to build upon previous investigations of OCD and suicide. So, we know from prior studies that individuals with OCD have three to five times the risk of attempting suicide and three to ten times the risk of dying by suicide compared to healthy populations. So, there’s certainly an increased risk of suicide in OCD populations. What really wasn’t noticed kind of the directionality of change and the association between OCD and suicide. So, really the question sought to answer does a greater severity of OCD symptoms at any given time predict subsequent suicide risk or is it really the opposite the case where suicide risk predicts subsequent OCD severity or can both things be true and is there bidirectional relationship.
Host: So, tell us a little bit about the results and some of your methods that you used.
Dr. Boisseau: So, we are fortunate. The data comes from a long standing investigation of individuals with primary OCD. And so, this is the Brown Longitudinal Obsessive Compulsive Study or what we call BLOC for short, so I will refer to it as that because it is just much easier than to say the whole thing. And really, the primary purpose of BLOC was to investigate course and outcome of 325 individuals with primary OCD. And so, this paper is part of that sample. And so, here I really looked at suicide and examined the first six years of BLOC’s data with those 325 adults.
And so, the methods are a little complex but basically, we used a statistical technique called Cross Lag Panel Analysis which allowed us to compare the associations between suicide, essentially testing four models to see which model provided the best set. And what we found is, we found that OCD severity is predictive of future suicidal ideations, however, in contrast, suicidal ideation wasn’t predictive of future OCD symptom severity. So really, it’s a unidirectional model and not a bidirectional model that was impacted from the data.
Host: Wow, so what do you want other providers Dr. Boisseau, to take from this segment and from your studies if they are working with patients that have OCDs and they are concerned and as you said, OCD patients are actually afraid of those things. What do you want them to take forward from this segment and learn from your study?
Dr. Boisseau: So, certainly I think it highlights what we already know and that individuals with OCD are at risk for suicide. And so, as clinicians, and researchers, it’s incumbent to ask those questions and to fully assess suicidal risk. And really, the goal then is to help individuals with OCD get the best possible treatment. And the good news is that with adequate treatment, most individuals with OCD do get better.
And so there are a lot of different empirically supported approaches one can take. So, there’s certainly behavioral approaches like exposure and response prevention essentially helping individuals with OCD confront the things that make them feel afraid without doing the behaviors that makes them feel better. So, without doing the things that actually maintains the disorder. So, someone with OCD, lets take contamination, might feel like oh well if I wash my hands then that makes me safe. That means I won’t get someone ill or get myself ill. But really the act, the behavioral thing they do, the washing their hands, reinforces the notion that something bad could happen. So, it reinforces those thoughts and makes them linger and actually get worse. And so, one of the most empirically supported treatments for OCD is actually helping people not do those behaviors that maintain their anxiety.
There are also other approaches. Certainly, we know that those selective serotonin reuptake inhibitors have shown efficacy in the treatment of OCD as well. And so, I think the study results certainly underscore the idea that you really need to assess for suicide in these patients, but also you need to help them find what we know to be really robust treatment.
Host: It’s great information. What an interesting study and what a fascinating topic. Dr. Boisseau, thank you so much for joining us today and welcome to the area. We are so pleased to have you here. This is Better Edge, a Northwestern Medicine Podcast for physicians. For more information on the latest advances in medicine, please visit www.nm.org, that’s www.nm.org. I’m Melanie Cole. Thanks so much for tuning in.
Obsessive Compulsive Disorder and Suicide
Melanie Cole (Host): Hello. Today, we are examining the relationship between OCDs and suicide. My guest today, is Dr. Christina Boisseau. She’s an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Northwestern Medicine. Dr. Boisseau, tell us a little bit about yourself to begin with and how you came to Northwestern Medicine.
Christina L. Boisseau, PhD (Guest): Yeah so, as you mentioned, I’m an Associate Professor in the department. And I actually joined the faculty at Northwestern earlier this year. And so, prior to that, I was faculty at Brown Medical School. And so really as part of my role here at Northwestern, I conduct clinical research, I also see patients, focus on OCD and anxiety disorders and I’m also the Associate Director of our Clinical Psychology Internship Training Program. So, I came from Brown and I’m a more recent transplant to Chicago.
Host: Well, we are so glad to have you here. Your research background, includes work investigating anxiety and obsessive compulsive spectrum and eating disorders. Tell us about your approach when you are examining the underlying diatheses both within and across the traditional diagnostic categories.
Dr. Boisseau: Well traditionally, researchers have focused on examining diagnostic categories. For example, individuals with social anxiety, individuals with panic disorder, individuals with depression and really my perspective is that there are more similarities than differences across these traditional diagnostic categories. So, for example, for a while we were treating all of these disorders with different treatment protocols. So, we had a different protocol for social anxiety, a different protocol for panic disorder, something different for depression. But really the treatment principles are largely the same.
So, in part of my work, I was part of the team that developed the unified protocol for transdiagnostic treatment of emotional disorders which essentially takes a more parsimonious approach and distills valid elements of existing empirically supported treatments to make a single protocol that can be used for many different conditions. And so, we think that this will be more easily disseminated to clinicians in the community because now you can use one protocol for social anxiety and OCD and depression instead of all of those disparate protocols.
More recently, my research has focused more on the translational aspect and so currently, we are examining underlying motivation across OC spectrum and anxiety disorders, really with the ultimate goal of delineating a circuit based model of the same. And here, we are focusing more on core motivation as opposed to whether or not an individual has let’s say social anxiety or hoarding. Really, we are looking at kind of why an individual does the behavior that they do.
Host: Typically, and before we discuss your research, Dr. Boisseau, are people with OCD who have these unwanted thoughts about hurting themselves or others; are they at a higher risk of acting on their fears?
Dr. Boisseau: No, not at all. And so, the thing to know about OCD is these are the people who are very, very afraid of their thoughts. So, they might have an intrusive thought of hurting a loved one. A common thing we often call them taboo thoughts because they are taboo in society is they have a thought if they pick up a knife, they are going to stab their loved one. And it’s really important to realize as a community that individuals with OCD are the least likely people to do this. They are afraid of this. They do anything in their power to not have these thoughts. So, these are the people who won’t go in their kitchen for example, because there are knives present. These are people who won’t hug their loved ones because they are afraid that something terrible is going to happen even if they may not be able to say what that terrible thing is.
Host: Wow, that’s fascinating. And you’ve recently published findings in the Journal of Affective Disorders, regarding obsessive compulsive disorders and suicide. Tell us about the background of your work and what the study sought to find.
Dr. Boisseau: Yeah, so the study was actually spearheaded by one of our collaborators. Her name is Dr. Lily Brown and she’s at U Penn and it was really designed to build upon previous investigations of OCD and suicide. So, we know from prior studies that individuals with OCD have three to five times the risk of attempting suicide and three to ten times the risk of dying by suicide compared to healthy populations. So, there’s certainly an increased risk of suicide in OCD populations. What really wasn’t noticed kind of the directionality of change and the association between OCD and suicide. So, really the question sought to answer does a greater severity of OCD symptoms at any given time predict subsequent suicide risk or is it really the opposite the case where suicide risk predicts subsequent OCD severity or can both things be true and is there bidirectional relationship.
Host: So, tell us a little bit about the results and some of your methods that you used.
Dr. Boisseau: So, we are fortunate. The data comes from a long standing investigation of individuals with primary OCD. And so, this is the Brown Longitudinal Obsessive Compulsive Study or what we call BLOC for short, so I will refer to it as that because it is just much easier than to say the whole thing. And really, the primary purpose of BLOC was to investigate course and outcome of 325 individuals with primary OCD. And so, this paper is part of that sample. And so, here I really looked at suicide and examined the first six years of BLOC’s data with those 325 adults.
And so, the methods are a little complex but basically, we used a statistical technique called Cross Lag Panel Analysis which allowed us to compare the associations between suicide, essentially testing four models to see which model provided the best set. And what we found is, we found that OCD severity is predictive of future suicidal ideations, however, in contrast, suicidal ideation wasn’t predictive of future OCD symptom severity. So really, it’s a unidirectional model and not a bidirectional model that was impacted from the data.
Host: Wow, so what do you want other providers Dr. Boisseau, to take from this segment and from your studies if they are working with patients that have OCDs and they are concerned and as you said, OCD patients are actually afraid of those things. What do you want them to take forward from this segment and learn from your study?
Dr. Boisseau: So, certainly I think it highlights what we already know and that individuals with OCD are at risk for suicide. And so, as clinicians, and researchers, it’s incumbent to ask those questions and to fully assess suicidal risk. And really, the goal then is to help individuals with OCD get the best possible treatment. And the good news is that with adequate treatment, most individuals with OCD do get better.
And so there are a lot of different empirically supported approaches one can take. So, there’s certainly behavioral approaches like exposure and response prevention essentially helping individuals with OCD confront the things that make them feel afraid without doing the behaviors that makes them feel better. So, without doing the things that actually maintains the disorder. So, someone with OCD, lets take contamination, might feel like oh well if I wash my hands then that makes me safe. That means I won’t get someone ill or get myself ill. But really the act, the behavioral thing they do, the washing their hands, reinforces the notion that something bad could happen. So, it reinforces those thoughts and makes them linger and actually get worse. And so, one of the most empirically supported treatments for OCD is actually helping people not do those behaviors that maintain their anxiety.
There are also other approaches. Certainly, we know that those selective serotonin reuptake inhibitors have shown efficacy in the treatment of OCD as well. And so, I think the study results certainly underscore the idea that you really need to assess for suicide in these patients, but also you need to help them find what we know to be really robust treatment.
Host: It’s great information. What an interesting study and what a fascinating topic. Dr. Boisseau, thank you so much for joining us today and welcome to the area. We are so pleased to have you here. This is Better Edge, a Northwestern Medicine Podcast for physicians. For more information on the latest advances in medicine, please visit www.nm.org, that’s www.nm.org. I’m Melanie Cole. Thanks so much for tuning in.